High Spatial Endothelial Shear Stress Gradient Independently Predicts Site of Acute Coronary Plaque Rupture and Erosion

2020 ◽  
Author(s):  
Vikas Thondapu ◽  
Chris Mamon ◽  
Eric K W Poon ◽  
Osamu Kurihara ◽  
Hyung Oh Kim ◽  
...  
Keyword(s):  
Shear Stress ◽  
Acute Coronary Syndromes ◽  
Plaque Rupture ◽  
Stress Gradient ◽  
Coronary Plaque ◽  
Oscillatory Shear ◽  
Oscillatory Shear Index ◽  
Plaque Erosion ◽  
Coronary Syndromes ◽  
Endothelial Shear Stress

Abstract Aims To investigate local haemodynamics in the setting of acute coronary plaque rupture and erosion. Methods and Results Intracoronary optical coherence tomography performed in 37 patients with acute coronary syndromes caused by plaque rupture (n = 19) or plaque erosion (n = 18) was used for 3D reconstruction and computational fluid dynamic simulation. Endothelial shear stress (ESS), spatial ESS gradient (ESSG), and oscillatory shear index (OSI) were compared between plaque rupture and erosion through mixed-effects logistic regression. Lipid, calcium, macrophages, layered plaque, and cholesterol crystals were also analysed. By multivariable analysis, only high ESSG (odds ratio [OR] 5.29, 95% confidence interval [CI] 2.57-10.89, p < 0.001), lipid (OR 12.98, 95% CI 6.57-25.67 p < 0.001), and layered plaque (OR 3.17, 95% CI 1.82-5.50, p < 0.001) were independently associated with plaque rupture. High ESSG (OR 13.28, 95% CI 6.88-25.64, p < 0.001), ESS (OR 2.70, 95% CI 1.34-5.42, p = 0.005) and OSI (OR 2.18, 95% CI 1.33-3.54, p = 0.002) independently associated with plaque erosion. ESSG was higher at rupture sites than erosion sites (median (interquartile range): 5.78 (2.47, 21.15) versus 2.62 (1.44, 6.18) Pa/mm, p = 0.009), OSI was higher at erosion sites than rupture sites (1.04x10−2 (2.3x10−3, 4.74x10−2) versus 1.29x10−3 (9.39x10−5, 3.0x10−2), p < 0.001), but ESS was similar (p = 0.29). Conclusions High ESSG is independently associated with plaque rupture while high ESSG, ESS, and OSI associate with plaque erosion. While ESSG is higher at rupture sites than erosion sites, OSI is higher at erosion sites and ESS was similar. These results suggest that ESSG and OSI may play critical roles in acute plaque rupture and erosion, respectively. Translational Perspective Plaque rupture and erosion are distinct pathological and clinical entities with possibly different optimal treatments. This study demonstrates that high endothelial shear stress gradient is independently associated with site of both rupture and erosion, and is significantly higher in rupture. High oscillatory shear index is independently associated with the site of erosion only, and is higher in erosion than rupture. Larger studies are necessary to determine whether these indices may detect and distinguish plaque rupture and erosion in a clinical setting or to assess overall risk for acute coronary syndromes.

Role of endothelial shear stress in the destabilization of coronary plaque: Acute coronary syndromes and rapid plaque progression

2012 ◽  
pp. 212-226
Author(s):  
Antonios P. Antoniadis ◽  
Michail I. Papafaklis ◽  
Saeko Takahashi ◽  
Charles L. Feldman ◽  
Peter H. Stone
Keyword(s):  
Shear Stress ◽  
Acute Coronary Syndromes ◽  
Coronary Plaque ◽  
Plaque Progression ◽  
Coronary Syndromes ◽  
Endothelial Shear Stress

scholarly journals Identification of the haemodynamic environment permissive for plaque erosion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Michael McElroy ◽  
Yongcheol Kim ◽  
Giampaolo Niccoli ◽  
Rocco Vergallo ◽  
Alexander Langford-Smith ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Fluid Dynamic ◽  
Stress Gradient ◽  
Plaque Erosion ◽  
Reference Segment ◽  
Stress Maximum ◽  
Relative Residence Time ◽  
Coronary Syndromes ◽  
Wall Shear

AbstractEndothelial erosion of atherosclerotic plaques is the underlying cause of approximately 30% of acute coronary syndromes (ACS). As the vascular endothelium is profoundly affected by the haemodynamic environment to which it is exposed, we employed computational fluid dynamic (CFD) analysis of the luminal geometry from 17 patients with optical coherence tomography (OCT)-defined plaque erosion, to determine the flow environment permissive for plaque erosion. Our results demonstrate that 15 of the 17 cases analysed occurred on stenotic plaques with median 31% diameter stenosis (interquartile range 28–52%), where all but one of the adherent thrombi located proximal to, or within the region of maximum stenosis. Consequently, all flow metrics related to elevated flow were significantly increased (time averaged wall shear stress, maximum wall shear stress, time averaged wall shear stress gradient) with a reduction in relative residence time, compared to a non-diseased reference segment. We also identified two cases that did not exhibit an elevation of flow, but occurred in a region exposed to elevated oscillatory flow. Our study demonstrates that the majority of OCT-defined erosions occur where the endothelium is exposed to elevated flow, a haemodynamic environment known to evoke a distinctive phenotypic response in endothelial cells.

Abstract 15794: Role of Endothelial Shear Stress and Endothelial Shear Stress Gradient in Plaques Associated With Acute Erosion vs. Stable Control Plaques

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Diaa A Hakim ◽  
Zhongyue Pu ◽  
Ahmet U Coskun ◽  
Natalia Pinilla-Echeverri ◽  
Olli A Kajander ◽  
...  
Keyword(s):  
Shear Stress ◽  
Stress Gradient ◽  
Coronary Event ◽  
Plaque Disruption ◽  
Plaque Erosion ◽  
Luminal Area ◽  
History Of ◽  
Endothelial Shear Stress ◽  
And Control

Introduction: The role of endothelial shear stress (ESS) in the natural history of plaque growth and TCFA formation/destabilization has been studied, but the role in plaque erosion is unknown. High ESS gradient (ESSG) has been hypothesized to promote plaque erosion, but no studies have included matched “control” stable plaques with the same minimal luminal area (MLA) and reference luminal area (RLA) but no adverse coronary event. Hypothesis: To compare ESS and ESSG between coronary plaques that developed erosion and similar morphology plaques that remain stable. Methods: We studied a subset of patients from both TOTAL and COMPLETE trials who underwent angiography and OCT evaluation: 27 patients (27 arteries: 18 LAD, 3 LCX, 6 RCA). Plaques were divided into Plaque Erosion (n=16) from TOTAL study with OCT features of plaque erosion and Control (n=11) plaques (non-culprit lesions from COMPLETE) with matched MLA and RLA and no OCT evidence of plaque disruption. Orthogonal angiographic views were used to generate a 3-D arterial reconstruction, and angio centerline was merged with OCT centerline. Local ESS distribution was assessed by computational flow dynamics and reported in consecutive 3-mm segments. Results: Table 1 shows differences in ESS between Plaque Erosion and Control Plaques Conclusions: In coronary plaques with similar severe obstruction (MLA) and reference area (RLA), plaque erosion is associated with higher coronary flow, max ESS, and ESSG in any direction, in the proximal-to-distal direction, and in the circumferential direction compared to plaques that remain stable. Future studies will determine which "feature (s)" of high ESS or ESSG are independently associated with erosion.

scholarly journals Seasonal Variations in the Pathogenesis of Acute Coronary Syndromes

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
Osamu Kurihara ◽  
Masamichi Takano ◽  
Erika Yamamoto ◽  
Taishi Yonetsu ◽  
Tsunekazu Kakuta ◽  
...  
Keyword(s):  
Seasonal Variations ◽  
Acute Coronary Syndromes ◽  
Plaque Rupture ◽  
Coronary Risk Factors ◽  
Plaque Erosion ◽  
Increased Risk ◽  
Incidence And Mortality ◽  
Calcified Plaque ◽  
Significant Difference ◽  
Coronary Syndromes

Background Seasonal variations in acute coronary syndromes ( ACS ) have been reported, with incidence and mortality peaking in the winter. However, the underlying pathophysiology for these variations remain speculative. Methods and Results Patients with ACS who underwent optical coherence tomography were recruited from 6 countries. The prevalence of the 3 most common pathologies (plaque rupture, plaque erosion, and calcified plaque) were compared between the 4 seasons. In 1113 patients with ACS (885 male; mean age, 65.8±11.6 years), the rates of plaque rupture, plaque erosion, and calcified plaque were 50%, 39%, and 11% in spring; 44%, 43%, and 13% in summer; 49%, 39%, and 12% in autumn; and 57%, 30%, and 13% in winter ( P =0.039). After adjusting for age, sex, and other coronary risk factors, winter was significantly associated with increased risk of plaque rupture (odds ratio [OR], 1.652; 95% CI, 1.157–2.359; P =0.006) and decreased risk of plaque erosion (OR, 0.623; 95% CI, 0.429–0.905; P =0.013), compared with summer as a reference. Among patients with rupture, the prevalence of hypertension was significantly higher in winter ( P =0.010), whereas no significant difference was observed in the other 2 groups. Conclusions Seasonal variations in the incidence of ACS reflect differences in the underlying pathobiology. The proportion of plaque rupture is highest in winter, whereas that of plaque erosion is highest in summer. A different approach may be needed for the prevention and treatment of ACS depending on the season of its occurrence. Registration URL : https://www.clini​caltr​ials.gov . Unique identifier: NCT 03479723.

Coronary plaque erosion developing in an area of high endothelial shear stress

2019 ◽  
Vol 30 (1) ◽  
pp. 74-75 ◽  
Author(s):  
Rocco Vergallo ◽  
Michail I. Papafaklis ◽  
Domenico D’Amario ◽  
Lampros K. Michalis ◽  
Filippo Crea ◽  
...  
Keyword(s):  
Shear Stress ◽  
Coronary Plaque ◽  
Plaque Erosion ◽  
Endothelial Shear Stress

scholarly journals A novel framework for fluid/structure interaction in rapid subject specific simulations of blood flow in coronary artery bifurcations

2014 ◽  
Vol 71 (3) ◽  
pp. 285-292 ◽  
Author(s):  
Milan Blagojevic ◽  
Aleksandar Nikolic ◽  
Miroslav Zivkovic ◽  
Milorad Zivkovic ◽  
Goran Stankovic
Keyword(s):  
Finite Element ◽  
Blood Flow ◽  
Shear Stress ◽  
Coronary Artery ◽  
Oscillatory Shear ◽  
Patient Specific ◽  
Oscillatory Shear Index ◽  
Structure Interaction ◽  
Endothelial Shear Stress ◽  
Lateral Walls

Background/Aim. Practical difficulties, particularly long model development time, have limited the types and applicability of computational fluid dynamics simulations in numerical modeling of blood flow in serial manner. In these simulations, the most revealing flow parameters are the endothelial shear stress distribution and oscillatory shear index. The aim of this study was analyze their role in the diagnosis of the occurrence and prognosis of plaque development in coronary artery bifurcations. Methods. We developed a novel modeling technique for rapid cardiovascular hemodynamic simulations taking into account interactions between fluid domain (blood) and solid domain (artery wall). Two numerical models that represent the observed subdomains of an arbitrary patient-specific coronary artery bifurcation were created using multi-slice computed tomography (MSCT) coronagraphy and ultrasound measurements of blood velocity. Coronary flow using an in-house finite element solver PAK-FS was solved. Results. Overall behavior of coronary artery bifurcation during one cardiac cycle is described by: velocity, pressure, endothelial shear stress, oscillatory shear index, stress in arterial wall and nodal displacements. The places where (a) endothelial shear stress is less than 1.5, and (b) oscillatory shear index is very small (close or equal to 0) are prone to plaque genesis. Conclusion. Finite element simulation of fluid-structure interaction was used to investigate patient-specific flow dynamics and wall mechanics at coronary artery bifurcations. Simulation model revealed that lateral walls of the main branch and lateral walls distal to the carina are exposed to low endothelial shear stress which is a predilection site for development of atherosclerosis. This conclusion is confirmed by the low values ??of oscillatory shear index in those places.

Sign in / Sign up

Export Citation Format

Share Document